Liu Dongli, Ma Lin, Shi Yi, Wang Anli, Liu Changhong
Institute of Pathogenic Microbiology, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an 710054, Shaanxi, China.
J Infect Dev Ctries. 2019 Dec 31;13(12):1174-1179. doi: 10.3855/jidc.11830.
Aureobasidium pullulans (A. pullulans) is a dematiaceous, yeast-like fungus that is ubiquitous in nature, which can colonize the human hair and skin. A. pullulans has been clinically implicated to cause skin and soft tissue infections, meningitis, splenic abscesses, and peritonitis. Herein, molecular diagnostic of internal transcribed spacer (ITS) sequencing was used to investigate a suspected case of A. pullulans infection, and the infection source had been traced. A 27-year-old female case was suspected of kala-azar due to the recurrent fever. Bone marrow specimens were analyzed. The samples were negative for Leishmania, Penicillium marneffei and Histoplasma capsulatum. DNA was extracted from the bone marrow specimens, and the 583-bp sequence was amplified with the fungal ITS universal primers. The sequence was compared by Blast query to be identified as A. pullulans. A strain of A. pullulans was also isolated from the kitchen of the patient's living room. Culture characteristics were the same as the human pathogens of A. pullulans, and the ITS sequence was identical to the bone marrow ITS amplification. In conclusion, a deep infection caused by A. pullulans is rare, often occurring in the indwelling catheter, which may cause peritonitis and other symptoms. ITS sequencing of fungi can be used as a diagnostic reference. As A. pullulans is a common fungus in environment, amplification of ITS sequence of A. pullulans in the aseptic body fluid would be necessary to make a comprehensive diagnosis based on the clinical symptoms and signs.
出芽短梗霉是一种在自然界中普遍存在的暗色、酵母样真菌，可寄生于人体毛发和皮肤。临床上，出芽短梗霉可引发皮肤和软组织感染、脑膜炎、脾脓肿及腹膜炎。在此，我们采用内转录间隔区（ITS）测序的分子诊断方法对一例疑似出芽短梗霉感染病例进行调查，并追踪了感染源。一名27岁女性病例因反复发热被怀疑患有黑热病。对其骨髓标本进行了分析。标本中利什曼原虫、马尔尼菲青霉和荚膜组织胞浆菌检测均为阴性。从骨髓标本中提取DNA，使用真菌ITS通用引物扩增出583bp的序列。经Blast比对，该序列被鉴定为出芽短梗霉。同时，在患者客厅厨房中也分离出一株出芽短梗霉。其培养特征与出芽短梗霉的人类病原体相同，ITS序列与骨髓ITS扩增序列一致。总之，出芽短梗霉引起的深部感染较为罕见，常发生于留置导管，可导致腹膜炎等症状。真菌ITS测序可作为诊断参考。由于出芽短梗霉是环境中常见的真菌，基于临床症状和体征进行综合诊断时，有必要对无菌体液中的出芽短梗霉ITS序列进行扩增。
